Διεγχειρητική Διαχείριση της Αλγαισθησίας: Ιατρική και βιοηθική διάσταση

According to IASP (International Association for the Study of Pain) the definition of pain is: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Furthermore, is expanded on: 1) Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons and 2) Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain. Continue reading →

Category: 2022, 2022b, Review Articles
Keywords: Bioethics, heart rate variability, Nociception, Pain Management, Patient’s Autonomy
Authors (a/b order): Katsanoulas K., Zafeiriadis D.

An interesting case of a sizeable adrenal incidentaloma resection in a 26-weeks parturient

Adrenal masses in pregnancy are extremely rare. Vascular rupture or venous thrombosis are the main complications and they are also related to increased morbidity and mortality.We present a case of a parturient in the 3^rd trimester of pregnancy with a sizeable adrenal mass, which was successfully and uneventfully resected. Continue reading →

Category: 2021, 2021d, Case Reports
Keywords: adrenal mass, incidentaloma, obstetric anesthesia, pregnancy
Authors (a/b order): Georgopoulou E., Katsanoulas K., Katsika E., Mavropoulos Ch., Tsakyridou E., Tzima M.

Postdural Headache

Postdural puncture headache (PDPH) may occur after inadvertent dura mater puncture inepidural anaesthesiaor after spinal puncture in spinal anesthesia, spinal diagnostic or therapeutic procedures. It is characterized by severe headache that occurs within 5 days following thepuncture, located in the frontal and/or occipital region, not necessarily worsened in the upright position. PDPH is associated with substantially increased postpartum risks of major neurologicand other maternal complications, underscoring the importance of early recognition, follow up andtreatment particularly in obstetrics. Despite the fact that epidural blood patch is recognized as thegold standard in the treatment of PDPH, it is not without risk andpotentially may fail. Nerve blocks andnewer therapieshave been reported that could be efficacious, easy to administer and with less risk. In this review wepresent updated evidence and potential alternative therapies in the treatment of PDPH. Continue reading →

Category: 2020, 2020c, Review Articles
Keywords: covid-19, epidural blood patch, greater occipital nerve block, Postdural puncture headache, postdural puncture headache treatment, sphenopalatine ganglion block
Authors (a/b order): Grousouzakou I., Katsanoulas K., Katsika E., Panteleou K., Tzima M., Zafeiriadis D., Zemou S.

CLINICAL SURVEY OF CURRENT ANAESTHETIC PRACTICE IN CAESARIAN SECTION IN A TERTIARY GREEK HOSPITAL

We have noted an ongoing interest for the anaesthetic practices for caesarean section (CS) throughout Europe, which may differ from one country to the other for several reasons. In a very recent EJA article, a national survey in the Czech Republic and Slovakia has shown that national audits may allow and promote focusing on education and interstate cooperation. Impressively, even if the two countries were united in the past, the rate of general anaesthesia (GA) for CS in the Czech Republic was lowered from 34 to 26% for elective and from 59 to 39% for non-elective CS. This was not the case for the neighboring Slovakia, where the rate for GA was already low. Besides, in a 2017 survey from Austria, the rate of routine use for regional anaesthesia for CS reaches almost 100% and in France has a similar trend. Continue reading →

Category: 2020, 2020a, Review Articles
Keywords: anaesthetic complications, Caesarean section anaesthesia, obstetric anaesthesia, regional anesthesia
Authors (a/b order): Bilali P., Georgopoulou E., Katsanoulas K., Katsika E., Panteleou K., Tzima M., Zemou S.

PERIOPERATIVE HAEMOSTATIC MONITORING: OLDER VS. NEWER CONCEPTS AND TECHNIQUES

Clinical management of acute severe bleeding in the perioperative setting is one of the major challenges for an anesthetic team. The dynamic nature of bleeding calls for rapid diagnosis and immediate interventions. Trauma induced coagulopathy and/or perioperative coagulopathy management is crucial for successful and life saving interventions, involving blood and blood product transfusions in an individualized and rationalized manner. Traditional coagulopathy monitoring using bleeding times offers very little in prediction and guidance during severe bleeding. They are mostly designed for stable patients under anticoagulant treatments and their very long turnaround time renders them impractical for clinical use in this setting. In contrast, viscoelastic devices are designed to assess whole-blood clotting kinetics and whole-blood clot strength and better reflect the interaction between pro- and anti-coagulants, pro- and anti-fibrinolytic factors, and platelets. The most notable advance in haemostatic management using viscoelastic testing is a fibrin-specific clot assessment. The system uses a combination of assays to characterize the coagulation profile for obtaining more detailed information about haemostasis and suggests the cause of the observed coagulopathy. The article offers a thorough and concise presentation of both traditional and viscoelastic methods and techniques in use during severe haemorrhage, followed by a literature review on the use of viscoelastic haemostatic monitoring in different clinical settings. Continue reading →

Category: 2019, 2019a, Review Articles
Keywords: bleeding times, coagulopathy monitoring, Haemostasis, point-of-care monitoring, thromboelastometry, viscoelastic haemostatic monitoring
Authors (a/b order): Katsanoulas K., Katsika E., Tzima M., Zemou S.

PROPHYLACTIC TRANEXAMIC ACID AND FIBRINOGEN CONCENTRATE USE FOR TRAUMATIC AORTIC RUPTURE

The case of a 33y old man is presented, who after a car accident, was transferred to the ED with a right hip dislocation and slightly obtunded but in a stable hemodynamic condition. After an emergent CT scan, a thoracic aortic rupture along with intestine rupture and retroperitoneal hematoma were noted. The patient was administered 1 g tranexamic acid (TXA) and 1 g fibrinogen concentrate (FC) preoperatively and then was transferred to the OR, where primarily, under monitored anesthetic care (MAC) the aortic trauma was restored intraluminally and then, under general anesthesia, he underwent laparotomy and hip dislocation reduction. During operation, no diffuse bleeding was noted, nor was any transfusion of blood or blood product necessary. After a short ICU stay the patient was discharged in good general health state. The aim of this case report is to present a case of traumatic aortic rupture bleeding, effectively managed with prophylactic tranexamic acid (TXA) and fibrinogen concentrate (FC) administration without need of any kind of transfusion. Continue reading →

Category: 2019, 2019a, Case Reports
Keywords: aortic rupture, major bleeding, Tranexamic acid
Authors (a/b order): Georgopoulou E., Katsanoulas K., Katsika E., Tzima M.

Editorial – Issue 2018a

Certainly, nobody during the autumn of 1990, when the 1^st Congress of Anesthesiology & Intensive Medicine was first inaugurated, had any idea of the impact and the influence this new institution would gain in the years to come. This very first congress was under the organizational presidency of Dr. Nikos Balamoutsos, respectable teacher and skillful director in the field.

But this was not a surprise; Thessaloniki had already experienced pioneering in Anesthesiology. Dr. Spyros Makris (1926-1978) was the first ever Professor of Anesthesiology in Greece (1974) at the Aristotle University of Thessaloniki. He wrote the very first textbooks of Anesthesiology in Greek and published more than one hundred papers, in Science, Anaesthesia and Analgesia, and other journals. This is the reason why during the opening ceremony, the honorary lecture has his name and is assigned to an academic with a broader scientific flair, normally from the local medical community.

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Category: 2018, 2018a, Letter from the Editors
Authors (a/b order): Katsanoulas K., Katsika E.

Eosinophilia: An early marker of adrenal insufficiency in critically ill patients with septic shock?

Adequate adrenocortical function is essential to survive critical illness. The goal of this study was to determine whether eosinophilia could serve as a useful and early marker of adrenal insufficiency in critically ill patients with severe septic shock. During a 1-year period, we prospectively studied 294 ICU patients.16 patients (5.4% of ICU admissions) with eosinophilia more than 3% of the white blood cell count and septic shock unresponsive to adequate fluid and vasopressor therapy, were included. A high dose (250 mcg i.v) corticotropin stimulation test was performed. Eosinophilia (>3%) was diagnosed in 16 patients with vasopressor-unresponsive septic shock. Eosinophilia was present 1.9±0.9d (range 8-96h) before the onset of septic shock. 11/16 patients failed to respond to corticotropin stimulation test above the critical level of 9 mcg/dL rise and 2/16 had baseline cortisol concentration <10 mcg/dL. Baseline cortisol level, maximal cortisol increase post-corticotropin administration and Eosinophils count (%) were higher in survivors (p≤0.05). A hydrocortisone infusion (300mg/d) treatment resulted in haemodynamic improvement in 12 of 16 patients (75%). The 28-day mortality (following the onset of septic shock) was 43.7%. Relative eosinophilia may be considered as a useful and early bioassay for adrenocortical function assessment in critically ill patients with septic shock and assumed adrenocortical depression.

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Category: 2018, 2018a, Clinical Studies
Keywords: adrenal insufficiency, Eosinophilia, severe septic shock
Authors (a/b order): Aslanidis Th., Katsanoulas K., Lampiri Cl., Mouloudi E., Papageorgiou Ch., Tholioti Th., Vrochides D.

Ethical dilemmas, end-of-life decisions and treatment de-escalation in the intensive care unit

Inevitably, ethical dilemmas and end-of-life decisions are issues that need to be faced in the common practice of intensive care units. In this review these dilemmas are approached through the medical ethical issues of patient autonomy, beneficence, non-maleficence and justice. Patient autonomy is further analyzed as opposed to medical paternalism with reference to historical, political, social and legal particularities.

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